Laser neurosurgery: A systematic analysis of magnetic resonance-guided laser interstitial thermal therapies

Laser ablation for mesial temporal lobe epilepsy: Surgical and cognitive outcomes with and without mesial temporal sclerosis

“…MRI-guided laser interstitial thermal ablation (MRIgLITT) was initially used as surgical treatment for patients with liver metastases, 1 tumors, and gliomas. 2 Over the past 5 years, Visualase (Medtronic, Englewood, CO, USA) and NeuroBlate systems (formerly AutoLITT, Monteris Medical, Inc, Plymouth, MN, USA), 3 gained acceptance for the treatment of epilepsy, and MRIgLITT became a widely used surgical alternative for mesial temporal lobe (MTL) epilepsy, [3][4][5][6][7][8][9][10] hypothalamic hamartomas, 11 periventricular nodular heterotopia, 12,13 cavernous malformations, 14 and focal cortical dysplasias. 15 The application of MRIgLITT in these cases is particularly appealing as it allows for a targeted lesioning of the putative ictal-onset zone, with little or no collateral damage.…”

Operative and peri‐operative considerations in the management of brain metastasis

“…LITT is a minimally invasive surgical intervention that utilizes a laser probe inserted through a burr hole to provide optical radiation that focally delivers thermal energy to induce cellular damage (Figure ). The procedure is guided by MRI thermography, and the intended increase in tissue temperature initiates a cascade of events including protein denaturation, enzyme expression, membrane disruption, vascular sclerosis, and coagulative necrosis . Advantages of LITT include safe access to lesions for which open resection is unappealing, obviating wound‐healing or intracranial scarring issues that complicate open surgery in patients with lesion recurrence after surgery or radiation, or providing an alternative to surgery for patients too medically frail for a craniotomy.…”

“…The procedure is guided by MRI thermography, and the intended increase in tissue temperature initiates a cascade of events including protein denaturation, enzyme expression, membrane disruption, vascular sclerosis, and coagulative necrosis. 121 Advantages of LITT include safe access to lesions for which open resection is unappealing, obviating wound-healing or intracranial scarring issues that complicate open surgery in patients with lesion recurrence after surgery or radiation, or providing an alternative to surgery for patients too medically frail for a craniotomy. Relative limitations to LITT include superficial or periventricular lesions (due to cerebrospinal fluid acting as a heat sink), although these are not absolute.…”

Laser Ablation for Gliomas

“…Within the probe, the laser fiber optic is ensheathed within catheter circulating cooled saline. Both systems have a computer workstation with software for MR thermal imaging analysis and control over laser treatment parameters [25]. The 1064 nm wavelength laser used in the NeuroBlate system allows for deeper tissue penetration and potentially larger ablation zone, while the Visualase 980 nm wavelength laser produces more efficient heating [9].…”